DESCRIPTION: (Provided by the Applicant) This application is re-submitted in response to PA-01-124, Patient-Centered Care: Customizing Care to Meet Patients' Needs. For a decade, attention has been given to the use of Advance Directives and Advance Care Planning (ACP) as ways to improve end-of-life care. We know from the literature, and from our own research on end-of-life care that these efforts have not been successful. The overriding inadequacy of past efforts is their lack of patient-centeredness. That is to say, they have not been grounded in a clear understanding of patients' preferences, values, and wishes, nor did they include surrogates. Based on theories regarding decision-making and patient education we have developed Patient-Centered Advance Care Planning (PC-ACP). This intervention is designed to improve patient and surrogate knowledge of ACP, increase the congruence between patient and surrogate in treatment decisions, decrease the patient's and surrogate's conflict in making such decisions, and increase the consistency between patient preferences and the actual care they receive. The ACP intervention is conducted with the patient in the presence of surrogate. The specific aims are (1) To test the efficacy of PC-ACP on patient and surrogate outcomes both immediately following receipt of the intervention and at six months and (2) To test the efficacy of PC-ACP on patient and surrogate outcomes at the time the patient first encounters a medical complication or during end-of-life care where the surrogate is required to make decisions. A randomized trial will be conducted with patients and surrogates experiencing conditions that put patients at high risk for dying within the next year - end-stage renal disease, and end-stage heart failure. Subjects (patient-surrogate pairs) will be randomized to PC-ACP or a control group. The control group will receive "usual care." Subjects will complete measures of clinical and demographic data when they enter the study. Outcome measures will be assessed at two end points, at the time of the first medical complication that requires surrogate decision-making and/or at six months. If successful, the knowledge gained from this research will be useful in redesigning the federally mandated assessment of Advance Directives into an improved process of Advance Care Planning to better fit the spirit of the Patient Self Determination Act.